PROJECT K9 SERVICES
WHY WE DO IT
Indicates required field
What services are you hoping to receive?
K9 Medical Needs
Branch of Service
General Law Enforcement
Military Discharge Category
Other than Honorable
Years of Service
Public Service Area
Conflicts Served In
Are you currently employed?
If yes, please include employer and average weekly hours.
How long is your K9 left alone?
How many people reside in your house?
Rent or Own
Do you have a fenced in yard?
Ages of those persons
Less than 13
How many dogs do you have?
Please list Names and Ages
Have you ever re-homed a dog?
If Yes, please explain the situation. If No, put N/A.
please describe why you chose Project k9 services and anything else you would like us to know to better understand your application.
Would you be willing to speak with media/press, share photos/videos, and speak with our partners to help us continue our work?
How did you here about Project k9 Services (pk9s)?
Shared Information Consent
Please read the Shared Information Consent Agreement in full and agree below:
By submitting this application I hereby give the Project K9 Services (PK9S) Staff, authority to use the information (including my participation in the PK9S program, verbal testimonies, quotations, photos, emails, text messages or any communication of any kind) shared by me on this day (the application date) or any day thereafter in any corporation-related promotional material including the PK9S websites, brochure, media, press releases, and merchandise.
I acknowledge and agree that PK9S, or others operating on behalf of PK9S may disclose to the public information that I provide to PK9S or its agents, including my Protected Health Information ("PHI"). This PHI may include my name, birth date, address, telephone number, diseases and ailments, medical records and treatment information. This agreement to disclose applies to any PHI governed and protected by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, as amended, and under the rules and regulations thereunder, as well as applicable state law.
PK9S may use and disclose the information provided, including PHI, for the business purposes of PK9S, including but not limited to education, fund raising, advertisement of PK9S, and support of other veterans and individuals who PK9S assists.
With respect to (1) all video footage, photographs recordings, and written materials provided by me to PK9S in connection with the Project K9 Services program; and (2) all print, video, film, recordings and written materials prepared by PK9S or its representatives in connection with the Project K9 Services program in which I appear or am referenced, including, but not limited to, photographs, print materials, commercials, film or video, social media posts, posting on websites or webcasts ((1) and (2) of this paragraph shall collectively be referred to as "Works"), I hereby grant to PK9S and its designees, including assignees and others that PK9S collaborates with, the unrestricted, perpetual, worldwide right to reproduce, copy, modify, create derivative works and otherwise use, display, distribute, exhibit, transmit and broadcast the Works or any part thereof in any media, means or embodiment, now known or hereafter to become known, including my voice, image and identity without further approval or payment to me of any kind. I also hereby waives any right of inspection or approval of my appearance in the Works.
I read and agree to the shared information consent agreement
Please send us an email to our secure address of the following documents that supports your information listed above.
Copy of a government issued ID
VA Identification Card
DD214 (Member 4 copy)
Place of Rental Agreement
proof of home ownership (
Rental agreement must contain applicants name and pet addendum. Home ownership documentation must contain applicant's name.)
127 F St.
Project K9 Services, Incorporated is a tax-exempt 501(c)(3) nonprofit organization. EIN #843885984
WHY WE DO IT